STEVE INSKEEP, HOST:
President Trump heads to Michigan and Tennessee today to help try to sell the Republican plan to overhaul the health care system. He's acting just days after a nonpartisan estimate looked at the Republican plan put out by the House Republicans. It found the bill would save money for the government but would also raise premiums for some people and millions of people would drop their insurance coverage in years to come. To find out what this means for one of the states the president is visiting today, we have called the governor of Tennessee, a state that voted big time for President Trump. The governor is Bill Haslam. He's on the line.
Governor, welcome back to the program.
BILL HASLAM: Well, good morning. Thanks for having me back on your show.
INSKEEP: It's good to talk with you. Is this bill good for Tennessee?
HASLAM: Well, we will see. I think it has the potential to be. I'm actually encouraged in conversations with both Secretary Price and CMS administrator Verma as recently as yesterday that they are listening to the states far more than has happened in the past. And they really are talking about giving us more flexibility. Now we have to see how that works out, but that's the encouraging thing to me.
INSKEEP: Although when you start looking at the numbers for specific people - there's some charts at npr.org based on the Congressional Budget Office estimates. And some people do better with health care subsidies under this plan. If you're 21 years old, you do a little better. If you're 40 years old and making a fair amount of money, you're doing a lot better in terms of the subsidy compared to Obamacare. But if you're in your 60s and not making a lot of money, maybe making something, you know, around $25,000, $26,000, it's devastating. You'd be asked to pay more than half your income in health care premiums. I would think there's a lot of people in Tennessee in that older, lower-income category.
HASLAM: I think there are - remember, when you're talking about the Affordable Care Act and the replacement of it, you're talking about two things. One - what happens with Medicaid? - which is where most of the people that are receiving, you know, either government-subsidized or government-paid-for insurance are. And then the second is - what happens on the exchange? On the exchange, Tennessee has been sort of ground-level - or ground zero, if you will, in the market of - the issue of insurers pulling out of the market.
HASLAM: We have just one provider in most of the state. And in one of our major areas of the state, potentially zero providers for the exchange. So something was going to have to be done to address the market to make certain we had providers. We were on a bad trajectory.
INSKEEP: So you would agree that some change needed to be made, and you certainly want something that opens up more competition so you have more choices of providers. But if you just look at the numbers, it's expensive to buy health insurance if you're in your low 60s. And if you're not making a lot of money and you're asked to pay $15,000 or something per year, it's going to be very hard to do that.
HASLAM: Right. So - I think that obviously is something that needs to be addressed. But again, we had a problem where we were in the sense that we didn't have any insurance - we were on the road to having either zero or one insurance providers in the current system so obviously that what we're doing now is not working either.
INSKEEP: OK. So you're willing to work on that and see what happens.
Now you mentioned Medicaid, the health care program for the poor. Tennessee, as I understand it, is not one of the states that expanded Medicaid. But it would still change the headline for people following this at a high level - is that money is taken out of Medicaid to go elsewhere. But people talk about flexibility for states. What does that mean? What does flexibility mean to you?
HASLAM: Well, currently, the guidelines around Medicaid have been very rigid in terms of what states could do or couldn't do. I'll give you one kind of easy example. If you are a Medicaid participant and you committed fraud, you could go right back on the program the very next day, and the state said we had no ability to do anything about that. In the current structure, depending on your state, the federal government takes 50 to 75 percent of the cost of Medicaid. In Tennessee, it's currently two thirds.
So right now, say two-third, one-third shift for us, but they get to make all the rules about what happens and who is covered. We have long felt we could cover more people in a more compassionate way if they would give us some flexibility around what the rules of Medicaid were - how they worked.
INSKEEP: Would you use that flexibility to take some health care off the table? Maybe the most expensive medicines wouldn't be paid for by Medicaid, for example.
HASLAM: Well, I think that's part of (unintelligible) - I mean, if it's a medicine that obviously is helping citizens without an alternative, I don't think we would take that off the table. If there's an alternative to that, then I think that is one of the things that could be looked at.
INSKEEP: This is a little complicated, but I want to ask the question. Right now, the federal government effectively guarantees you get a certain level of service if you're in Medicaid in whatever state.
INSKEEP: And if more people go on Medicaid because there's a recession and people are unemployed...
INSKEEP: ...Then the federal government is going to pay. Now they want to change it so you just get a set amount of money per capita in the state of Tennessee. What happens if there's a recession and you suddenly have a lot more people on Medicaid?
HASLAM: Well, under the block grant program, that's what would happen. And states would be in a tough situation. Under the per capita model that we're talking about, if there's recession and more people come on to Medicaid, then they would cover that. The danger for states would be more along the lines of - let's say a new drug comes on the market that costs, you know, $95,000 per regimen.
Your prior formula hadn't really taken that into account. Under the new world, the state would be responsible for that. There are several things like that that could change that would impact states. Again, I think most states feel like we do. If you'd give us a little bit more control, we think we can still manage our way through that. But there's no question that states have increased exposure and increased risk under this formula.
INSKEEP: Would you insist, Governor, that some changes be made to this health bill, if it were up to you, before it becomes law?
HASLAM: Sure. I mean, I don't know many people that think that this is the final draft. I think that the people that phrase this in the terms of, this is the first draft, probably more reflect my thinking. There are definitely still some changes that can and need to happen on this.
INSKEEP: One thing that you want to happen?
HASLAM: Well, I would - for me, I'd like to have some more definition around what the flexibility that states are going to have. So there's a lot of talk about that, and we've had good conversation so far - way better conversation than I've ever had since I've been in office with both Congress and the administration. But I think we all want to be specific. As states, we're taking on more responsibility. Exactly what will that flexibility look like?
INSKEEP: In a few seconds, will you get a chance to talk to the president today?
HASLAM: He will be in Nashville, and he's coming to visit the Hermitage, Andrew Jackson's home, and then have a rally in downtown Nashville. So we look forward to having him here. You know, regardless of your party, when Air Force One pulls up on the tarmac, it's a - and everything that's represented by the United States of America, it's an impressive sight.
INSKEEP: OK. Well, Governor, thanks very much. Real pleasure talking with you. So much more...
INSKEEP: ...To discuss.
HASLAM: Thanks, Steve.
INSKEEP: Bill Haslam is the governor of Tennessee. He's a Republican. And Tennessee will be hosting President Trump today. Transcript provided by NPR, Copyright NPR.